BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 67 of 2015
Date of Institution: 27.3.2015
Date of Decision : 23.12.2016
Raj Kumar @ Raju son of Kala Ram, resident of village Bora, Tehsil Ratia, District Fatehabad.
…Complainant.
Versus.
1. HDFC Standard Life Insurance Company Limited, Branch Sirsa, 1st floor, Classic Auto Care Sangwan chowk, Opp. Sharma Petrol Pump, Dabwali Road, Sirsa-125055, through its Branch Manager.
2. HDFC Standard Life Insurance Company Limited, 11th floor, Lodha Excelus, Apollo Mils Compound, N.M. Joshi Marg, Mahalaxmi Mumbai 400011, through its Managing Director / Authorized person.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SHRI S.B.Lohia …………………PRESIDENT
SHRI RANBIR SINGH PANGHAL ……MEMBER.
Present: Sh. Ravinder Singh, Advocate for the complainant.
Sh. Ashish Goel, Advocate for opposite parties.
ORDER
In brief, the case of the complainant is that his father Kala Ram, since deceased had purchased a insurance policy No.15585389 for the sum of Rs.4,93,519/- from the opposite parties by making payment of premium to the ops. As alleged, at the time of insurance, insured was hale and hearty and was also got checked up by the doctor on panel of company. The insured died suddenly due to heart failure during the policy period. Being nominee and legal heir, he lodged his claim with the ops for the benefit of the policy. The grievance of the complainant against the ops is that vide letter dated 27.12.2013 ops wrongly repudiated his genuine claim on the false ground that insured was suffering from Septicemia and renal failure prior to the purchase of policy and same was not disclosed at the time of insurance. Hence, this complaint seeking the relief as detailed in prayer clause of the complaint.
2. On notice, ops appeared and replied that cardinal principle of contract of life insurance is Uberrama Fides i.e. the principle of utmost good faith. It is further replied that at the time of issuance of policy, the insured was suffering from Septicemia and renal failure and was under treatment of the same. But insured concealed the fact of his ailment and purchased the policy by making wrong statement. As such, they have rightly repudiated the claim of the complainant and complaint is liable to be dismissed.
3. By way of evidence, complainant filed his affidavit Ex.C1, repudiation letter dated 27.12.2013 Ex.C2 and copy of policy Ex.C3. Whereas the ops produced affidavit of Sh. Amit Khanna, Deputy Legal Manager Ex.RW1/A, copy of policy with proposal form Ex.R1, copy of death certificate Ex.R2, copy of claim form Ex.R3, letter Ex.R4, acknowledgment of documents Ex.R5, letter dated 27.8.2013 Ex.R6, copy of investigation report Ex.R7, copy of ration card Ex.R8, doctor’s/ hospital certificate Ex.R9, copy of prescription slip dated 31.10.2012 Ex.R10 and copy of repudiation letter Ex.R11.
4. We have heard learned counsel for the parties and have gone through the case file carefully. Written argument submitted on behalf of ops also perused.
5. The main question to be determined is that whether ops rightly repudiated the claim of the complainant or not on the basis of concealment of pre-existing disease of the insured? To answer this question, we have gone through various documents placed on file by the opposite parties. From the perusal of Ex.R1 proposal form dated 19.11.2012, it is clear that insured had given the negative answers with regard to his state of health specially to the questions No.31, 34, 37 and 39 of the proposal form as also discussed in Ex.C2 and Ex.R11 while repudiating the claim of complainant. The policy in question was purchased by the insured on 19.11.2012 whereas he expired on 25.11.2012 as is evident from copy of death certificate Ex.R2. To determine the fact whether insured was suffering from any disease as alleged by the ops prior to the purchase of policy in question, we have carefully gone through the copy of doctor’s/ hospital certificate issued by Dr. Pankaj Goyal of Paul Clinic, Ratia Ex.R9 and copy of prescription slip dated 31.10.2012 Ex.R10 placed on the file and from these documents i.e. medical record available on the file it is clear that before proposing for the policy in question, insured was suffering from the disease as alleged by the ops in their version. So, it is clear that insured concealed the fact of his ailment at the time he proposed for the purchase of policy from the ops in proposal form Ex.R1. Learned counsel for complainant has argued that ops have not proved the medical record as per law and have only relied upon photostat copies. But we see no substance in this contention because such records of hospitals cannot be manipulated. In this regard we are also fortified with the observations of Hon’ble National Commission in case titled as ICICI Prudential Life Insurance Co. Ltd. & ors. Vs. Yashika @ Meera & Ors. Revision Petition No.470 of 2015 decided on 4.11.2015 relied upon by learned counsel for ops. The authority cited by learned counsel for complainant in cases titled as LIC Vs. Priya Sharma & Ors. 2012 (4) CPJ 646 (NC), Bajaj Allianz Life Ins. Vs. Raj Kumar, 2014 (3) CPJ 221 (NC), SBI Life Ins. Co. Vs. Harivinder Kaur and anr. 2014 (3) CPJ 552, Kotak Mahindra Old Mutual Life Ins. Vs. Veena Rani 2015 (4) CPJ 37 (Punjab State Commission) and The Branch Manager, SBI Life Ins. Vs. Bina Ghosh, 2016 (2) CPJ 150 are not applicable in this case. Thus, we are of the considered view that there is no deficiency in service on the part of ops while repudiating the claim of the complainant on the basis of concealment of material fact of pre-existing disease. Reliance in this regard is also placed on the observations of Hon’ble National Commission in case titled as Jagdeep Arora Vs. Life Insurance Corporation of India & others, revision petition No.4375 of 2014 decided on 25.5.2015 relied upon by learned counsel for ops.
6. Thus, as a sequel to our above discussion, we find no merit in the present complaint and same is hereby dismissed with no order as to costs. A copy of this order be supplied to the parties as per rules. File be consigned to the record room after due compliance.
Announced in open Forum. President,
Dated:23.12.2016. District Consumer Disputes
Member Redressal Forum, Sirsa.
